Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings

Background

Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences.

Aims

To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field.

Methods

Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected.

Results

While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts.

Conclusion

Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.     

Quantitative oral health assessments in mechanically ventilated patients: A scoping review

Background

Oral health is a key contributor to a person's overall health. Previous studies indicate that oral health deteriorates throughout ventilation and may contribute to the development of ventilator-associated pneumonia (VAP). Oral health at the time of initial ventilation may impact on this deterioration.

Aims

To determine the quantitative clinical assessment methods used to measure oral health and what is currently known regarding the oral health of patients at the time of initial ventilation.

Study Design

A systematic literature search using electronic bibliographic databases MEDLINE/PubMed, Embase, CINAHL, and the Cochrane Library was undertaken for this scoping review. Studies were included if patients were >18 years old and mechanically ventilated for <48 h at the time of the first oral assessment.

Results

In total, 12 studies were included. The review demonstrates a limited understanding of clinical oral health at the time of initial ventilation. Significant variation in both assessment methods and reporting of oral health makes comparison of results difficult resulting in a poor overall understanding of oral health at the time of intubation.

Conclusion

Standardized assessment and reporting methods may improve clinical application of findings and help direct future research. We suggest developing a core outcome set to ensure consistent use of assessment tools as well as standardized reporting of results.

Relevance to Clinical Practice

It is essential that a good understanding of oral health at the time of initial ventilation is gained so that patients receive more targeted oral hygiene intervention in ICU, potentially leading to improved patient outcomes.     

Noninvasive lipolysis modalities in aesthetic medicine

Background

Adipose tissue is a vital metabolic organ that takes part in body homeostasis. However, an increase in fat tissue can be detrimental for one's health and lead to undesirable changes in body shape. Noninvasive lipolysis is becoming an increasingly popular method to destroy and remove excess body fat and improve one's satisfaction with their body appearance.

Aim

The aim of this study was to perform an evidence-based review of the clinical efficacy and safety of noninvasive lipolysis modalities in fat reduction.

Materials and Methods

An evidence-based review was performed to evaluate the scientific evidence available on the subject. Three electronic databases (PubMed, Scopus, and Embase) were searched between February and May 2022 for randomized controlled trials and observational studies performed on adult population in the last 20 years investigating the clinical outcomes of noninvasive lipolysis modalities. The selected studies were divided by modality type (cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy), and the data on the efficacy and safety were extracted.

Results

In total, the search identified 55 papers which met the inclusion criteria. All four energy-based modalities, including cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy, were shown to be clinically effective in terms of both objective body measurements, such as fat layer thickness or circumference reduction, and subjective patient satisfaction. Furthermore, the abovementioned methods were proven to have a low side effect profile.

Conclusion

In conclusion, although evidence supports safety and efficacy, further well-designed trials are needed to strengthen confidence in long-term effectiveness and safety of noninvasive lipolysis.     

Double-Crown Prosthesis Retention Using Polyetherketoneketone (PEKK): An In Vitro Study

Purpose

To assess the retentive force of telescopic crowns using polyetherketoneketone (PEKK) high-performance polymer in relation to conventional materials over a long period of time in an in vitro setting.

Materials and Methods

Thirty-six sets of primary and secondary crowns were fabricated as per the double crown-retained prostheses approach. Six samples were included in each of the five test groups (1: zirconia/PEKK [Zr/PEKK]; 2: titanium/PEKK [Ti/PEKK]; 3: cobalt-chrome/PEKK [CoCr/PEKK]; 4: PEKK/PEKK; and 5: gold/PEKK [Au/PEKK]) and the single control group (gold/galvano-gold [Au/GA]). The insertion-removal test was performed for 20,000 cycles, and the surface condition was observed. Retentive forces were analyzed using two-way ANOVA (α<0.05).

Results

The retention forces in groups Zr/PEKK and Ti/PEKK significantly decreased over time (group 1: p = 0.035 and group 2: p = 0.001), whereas retentive force increased significantly in groups PEKK/PEKK, Au/PEKK, and control (group 4: p = 0.001, group 5: p = 0.008, and control: p = 0.042). Similar wear was observed on the primary crown in groups PEKK/PEKK, gold/PEKK, and control.

Conclusions

Groups PEKK/PEKK and Au/PEKK showed a transition of retentive force similar to the control group. Groups PEKK/PEKK and Au/PEKK had similar wear on the surface compared to control. Therefore, PEKK has a promising clinical potential.